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What is Normal?

In my short time as a dental hygienist I have had many patient ask me about “weird” things they have noticed inside their mouths. Many patients are worried or scared they might have oral cancer. While oral cancer should be checked regularly, many times the things patients are worried about are completely normal. In general, most mouths have the same or similar anatomy. However, there are variants of normal that one person may experience over another. I have listed a few of these normal variants here:

Tori: A torus or tori (plural) is simply an excessive growth of normal compact bone, either on the floor or roof of the mouth. They develop gradually and are asymptomatic. Tori can grow into many different shapes and sizes and are covered by the normal soft tissues of the mouth. Tori may make taking radiographs very uncomfortable or painful. No treatment is needed unless the patient is having problems speaking or swallowing. Even upon removal tori may grow back.

Fordyce granules: Fordyce granules are simply a cluster of sebaceous glands (glands that secrete oil, similar to a pimple) inside the mouth. Usually they occur on the inside of the cheeks or on the lips. They are yellow in color and more than 80% of adults over the age of 20 experience them. Fordyce granules are also asymptomatic and do not require treatment.

Lingual varicosities: Lingual varicosities are veins under and on the sides of the tongue. They can be red, blue, or purple in color and generally occur in clusters. Everyone has veins in and around the tongue that may vary in size, shape, or color.

Linea alba: Linea alba is a raised, white line usually along the inside of the cheek. It occurs as a result of clenching or biting the inside of one’s cheek. No treatment is necessary.

Luekoedema: Leukoedema is a generalized opalescent appearance of the inside of the mouth. It most commonly occurs in black adults but can be seen with any ethnicity. When the mucosa is stretched the opalescence is less noticeable. No treatment is necessary.

Amalgam tattoo: Believe it or not, I have seen tattoos inside the mouth! However, an amalgam tattoo is a little different. These “tattoos” result from previous amalgam (silver) fillings where part of the filling material seeps into the tissue. It creates a bluish-gray lesion and they can occur anywhere an amalgam filling has been placed. Amalgam tattoos can look very similar to oral cancer because of their color. A biopsy can determine the difference. Amalgam tattoos generally do not require treatment.

Fissured tongue: Believed to be a result of familial genetic patterns, this variant is seen in about 5% of the population. It involves deep fissures or grooves on the dorsal (backside) of the tongue. Sometimes the tongue can become irritated if food or bacteria remain in the grooves for an extended period of time. No treatment is needed other than brushing the tongue to remove food/bacteria from the surface.

Geographic tongue: Geographic tongue appears as small, red patches on the dorsal (backside) of the tongue that are surrounded by a yellow or white perimeter. The appearance is similar to that of landmasses on a globe, hence the name “geographic” tongue. The patches may go away and return again in different areas. Stress can be a contributing factor to this condition. No treatment is needed.